Medicine and the Humanities in Medical School Curricula
C Bartholomew
I was given the choice of three subjects about which to speak
today. The first was entitled The Tsunami of HIV/AIDS –
Social and Economic Impact. However, I am no expert in the
non-scientific aspects of AIDS and I am neither in the Faculty
of Sociology nor Economics. The second choice was Spiri-
tuality in Medical School Curricula, a very important topic
and typifies the broad outlook of Professor Barton. In fact, I
will include a little aspect of this in my talk today. The third
choice was Medicine and the Humanities in Medical School
Curricula. This was an offer that I could not refuse.
Indeed, as early as the 1970s, I have been advocating to
the Faculty Board at the University of the West (UWI) Trini-
dad and Tobago that a certain percentage of slots for ad-
mission into medical school should be reserved for applicants
who have high grades in General Certificate of Education
(GCE) and advanced levels in non-science subjects but with
good GCE ordinary level grades in biology and chemistry,
and who wish to enter medical school.
However, it may be said that it all came to a head last
year when two of my staff at the Medical Research Centre of
Trinidad and Tobago of which I am the director, were not
admitted to medical school at the St Augustine campus of
UWI located at Mt Hope, following which I began a cam-
paign to change the entry requirements there. One had a
Masters degree in Public Health from Tulane University in
New Orleans, USA. The other had a BSc with honours from
an internationally-recognized university in New York. But
because they both did not have an A in Physics, an A in
Chemistry and an A in Mathematics when they were in
college (college level, mind you), they did not qualify for
entry in Mt Hope! Fortunately, they were both accepted by
the medical school of this Jamaican campus for which I thank
you.
Undoubtedly, they are only two tips of the large iceberg
of rejected applicants in the medical school of the St
Augustine campus. The selection and promotion process at
this campus is much more complex than meets the eye. But
I am not going there today.
As you know, the European and, above all, the
American systems require a first degree for entry into medi-
cal school. So said, there are many reasons why the standard
of medicine and science in general is much higher in the
United States of America (USA) than the rest of the world
and I do believe that part of that success starts with the
embryonic period of the pre-medical education programme.
Delivered by: Professor Emeritus Courtnay Bartholomew at the distin-
guished lecture series of the Department of medicine, Mona, Jamaica. He
dedicated this to Professor Charles Denbow.
West Indian Med J 2009; 58 (2): 84
In my opinion, it is a programme which helps to foster a
broad knowledge, independent thinking and research.
On the other hand, Jules Dienstag, a celebrated hepa-
tologist of international repute and Dean for medical edu-
cation at Harvard Medical School, Boston, criticizes the US
college curriculum. He wrote in the New England Journal of
Medicine: “The college courses that fulfill administration’s
requirement to medical school are not adequately focussed
on human biology, and the topics covered in the many
courses in chemistry, physics and mathematics are so re-
moved from human biological principles that they offer little
value to the premedical student and steal time and attention
from more relevant science preparation. Does a student, for
example, really need a full year of chemistry to prepare for
the study of biochemistry? Moreover, pre-medical science
courses often fail to achieve sufficient rigour to prepare
students for taking the sciences fundamental to medicine at
the advanced molecular level now required.”
He supported greater efficiency and a higher focus on
science that really “matters” to medicine. He felt that col-
leges should expose premedical students not only to general
chemistry, but also to introductory biochemistry that provides
the foundation for the study of biologically-relevant chemis-
try, building a foundation for medical school courses that
begin at and reach higher plateaus. In fact, how well I re-
member a certain disconnect between the chemistry I learnt
in college and the biochemistry I had to learn in medical
school. He believed that courses should also provide an in-
troductory grounding in probability and statistics which are
required for understanding the scientific and medical liter-
ature of today.
Moreover, Dienstag believed that because human be-
ings are complex organisms whose discrete systems are
linked intricately and elaborately within the body and modi-
fied profoundly by external influences, we need to teach in
ways that reflect this complexity. In short, the patient does
not represent a biochemistry problem, an anatomy problem,
a genetics problem or an immunology problem, rather each
person is a product of myriad molecular, cellular, genetic,
environmental and social influences that interact in complex
ways to determine health and disease.
Our teaching, therefore, ought to echo this conceptual
framework that cut across disciplines. Many universities
agree with this philosophy but whether it is properly and
adequately conducted is another matter as it defies the tradi-
tional compartmentalization of disciplines into departmental
silos. Of course, another major concern is whether traditional
lecturers are prepared to change. Apropos this, for example,
 Bartholomew
I am not quite sure that the so-called problem solving pro-
gramme is being properly practised.
In addition, and this is most important, the college
period should be a time to explore and stretch, not only aca-
demically but intellectually engaging creatively in an expan-
sive liberal arts education encompassing literature, langu-
ages, the arts, humanities and social sciences to prepare for
citizenship in society. Included in this foundation should be
analytical writing and communication skills, fluency and a
nuanced facility in English, and even perhaps the mastery of
a foreign language, achieving cultural awareness and facili-
tating the habit of a life long self-education and in-depth sus-
tained independent study, which fosters a well rounded edu-
cated individual.
Now, Dr Sandeep Jauhar, an assistant professor of me-
dicine at Albert Einstein College of Medicine in the Bronx,
New York, also wrote that he entered medical school at the
age of 26 years, and said that he was considered to be a non-
traditional student. He was hardly alone. A middle age wo-
man in his class had an advanced degree in cell biology, one
classmate in his early 30s had been a physician’s assistant for
10 years. In fact there was also a lawyer in his class. As he
wrote: “We were the new face of medicine, or so we were
told, and there was considerable interest in us from
professors and administrators, if not our classmates”.
So said, in the USA, the mean age of first-year medical
students today is about 24 years, though 10% are 27 years or
older. Indeed, medical schools now routinely admit students
in their 30s or 40s who already have families or are well into
another career before turning towards medicine. Indeed,
these students are welcomed into the profession there, as they
bring maturity, diversity, a broader perspective and also life
experiences. It is also observed that older students tend to
ask smart questions and challenge assumptions. They bring
diverse experiences that improve a class. They are more cer-
tain about their career choices and have a greater ability to
deal with emotional distress and a clearer sense of what they
want to do in medicine
According to Dr Scott Barnett, associate dean for ad-
missions and graduate medical education at New York’s
Mount Sinai School of Medicine: “At our school, 50% of
medical students are non-science majors. Out of 140 stu-
dents, a quarter are from our undergraduate humanities in
medicine programme, 10% are PhDs and quite a few are
career changers. Such students are at the forefront of our
school. They are older and have a broader view of the world.
In fact, we have realized that the conventional biology major
may not be necessary to produce competent, morally and
ethically upstanding citizens and doctors.”
Lawrence Smith, former dean of medical education at
New York’s Mount Sinai Medical School, also said that non-
traditional students are often a challenge to medical educa-
tors. “They are more self-confident. They are more con-
scious of what they want to do with their time. They are not
just willing to just work through their rote aspects of medical
training. They are the ones you see in the dean’s office
saying: “Don’t inflict this horrible teacher on me.” At the
same time, they bring an integrative, adult vision of the work
to medicine. They excel in the clinical setting. They ask
more questions. They challenge assumptions. They ask
“why” more than younger students. They are more com-
fortable dealing with people. I am not 100% sure that they
all necessarily make better doctors but I think the class is
definitely enhanced by their presence.”
Leslie Khal, dean of students’ affairs at Washington
University School of Medicine, in St Louis, said the decision
of such students to enter into medicine is almost always self-
conscious. My sense is that they are more focussed. More
goal-oriented when they arrive. They bring a different,
slightly more mature or empathetic approach towards their
own patients. In fact, many non-traditional medical students
themselves believe that they have advantages over their
younger counterparts – greater sensitivity, interactions with
patients, more certainty about their career choices, a greater
ability to deal with emotional distress and a clearer sense of
what they want to do with their medicine.
These characteristics are important ingredients for
admission to medical school. But here lies the rub. All this
also calls for a mature, highly qualified, culturally – sensitive
and experienced medical school admissions committee,
which, in my opinion, should also include highly-respected
elders from certain other faculties, for example, social
sciences and other departments of the humanities.
Now, why is it that I sympathize with the opinion of
these American deans. My response to that, among other
things, is that I was admitted to medical school in University
College Dublin, a university with a long tradition of scholar-
ship, with A’ level subjects, not in physics, chemistry and
mathematics but in English Language, English Literature,
French, Spanish, Spanish Literature and Latin, but with che-
mistry and biology at O’level. Throw in Greek for good mea-
sure. Moreover, I did not enter medical school immediately
after leaving colleage at the age of 19 years but at age 24
years after working for 4 years in Her Majesty’s Customs and
Excise Department in Trinidad and Tobago, as it was called
in those days, and after attaining many life experiences. Yet
I was appointed the first Trinidadian professor of medicine. It
tells a story.
I also strongly believe that no university worth its salt
does not have a very strong and internationally-recognized
research reputation. Indeed, where would science and all the
other disciplines be without high-level research. In my case,
I was fortunate in Dublin, Ireland, to have worked with a
Professor of Medicine who also focussed on research on the
pancreas and then Professor Dame Sheila Sherlock, the
queen of the liver, as I like to call her, at the Royal Free
Hospital in London, who devoted her career to research on
the liver, not to mention another stint at the teaching hospital
 Bartholomew
of McGill University in Montreal where I was a research
fellow in gastroenterology for 2 years. These exposures cer-
tainly broadened and shaped my medical outlook.
I do recognize however that good research needs a
costly budget but one can always get collaboration from US,
British or Canadian research institutions if an interesting re-
search observational project is presented to them. Professors
Nigel Gibbs, Barry Hanchard, Owen Morgan in Jamaica and
myself in Trinidad and Tobago have benefited from such
collaborations with the National Institutes of Health of the
USA.
In recent years, calls have also come from various
quarters for medical schools to teach ethics, altruism and
compassion. I also feel strongly about this as I witness the
progressive commercializing of medicine in my country and
doctors who look at medicine as a business rather than a
privilege; doctors who in many cases charge exorbitant fees
even to poor people and doctors who are prepared to go on
strike at the expense of patient care. The medical school
must bare some responsibility for that. Surely, it is accep-
table that professionals should be financially rewarded but to
exploit sickness to gain undue wealth is, to me, immoral.
I also feel that to broaden the education of our students,
they need to be exposed to first world hospitals with higher
levels of medical care and expertise. In fact, it is standard
practice in the USA Canada and England and even Australia
for students to have a six-week or two-month elective period
to observe medicine in another setting, particularly in first
world countries but even also in third world settings.
So said, the Dean’s office should be more engaged in
arranging elective experiences for our medical students to
spend a month or two in university hospitals abroad and in
this process do away with an overcrowded undergraduate
medical curriculum, which promotes book work and book
learning, a cram school, without life experiences.
As for spirituality in medical schools, as early as the
fourth century, Augustine of Hippo recognized the respon-
sibility and irresponsibility of scientists of the time and in
Book 5 of his Confessions, he criticized them thus: “It seems
to me that the scientists were able to think clearly enough to
form a clear judgment of the universe, even though they
could not penetrate through to its sovereign Lord. That is
because such men fall into pride. They accurately predict the
eclipse of the sun, then fall into a state of eclipse themselves.
They neglect to investigate the source of the intelligence by
which they conduct their research. Much of what the natural
philosophers and scientists are saying about the universe is
true, but they show no interest in a devout search for the
Truth who put the universe together. So they fail to find Him
or if they do find Him, they do not honour Him as God or
give thanks to Him.”
More recently, on September 24, 1989, John Paul II
gave a talk on science and faith to professors and students of
85
the University of Pisa, Italy, where the once controversial,
now vindicated, Galileo, the professor of mathematics,
taught. He began his address by speaking about the links
between religion and the Chairs of the science, which make
up the university. He said: “People of science are also called
upon to practise their own special priesthood. Yes, in a cer-
tain sense, every true scientist is a priest. Precisely because
they perceive more, and more profoundly, the more is their
duty, on one hand to recognize, praise, admire and find God
in all the elements of His creation, and, on the other, to make
an honest and responsible use of their own ingenuity and the
great achievements which spring from it.”
And so, all of us doctors are called upon to practice a
certain aspect of priesthood. This would certainly include
ethical conducts in the practice of medicine, compassion, and
of course, charity even to the extent of not charging a patient
who is unable to afford your fee.
But, above all, the doctor, in whatever specialty he
chooses, must be scientifically humble. As Louis Pasteur, a
very religious scientist, once quipped: “A little acquaintance
with science distances us from God; greater acquaintance
with science brings us closer to Him.” Professor Christian
Anfinsen of Johns Hopkins University and winner of the
1972 Nobel Prize for chemistry, once wrote: “Only an idiot
can be an atheist.” He then quoted a favourite quotation from
Albert Einstein: “The most beautiful and the most profound
emotion we can experience is the sensation of the mystical. It
is the sower of true science. That deeply emotional convic-
tion of the presence of a superior reasoning power which is
revealed in the incomprehensible universe forms my idea of
God.”
It is therefore easy to recognize the truly great scientist.
He is the one who is humble and believes in God. Indeed,
when the question was posed to him: “How should science
and the scientist approach origin questions, specifically the
origin of the universe and the origin of life?” Professor
Ragnar Granit of the University of Helsinki winner of the
Noble Prize for his discovery concerning the primary phy-
siological and chemical visual processes in the eye, replied
briefly and to the point: “Humbly.”
Now, most of you students in this audience have gained
entry into medical school under the British system of A’ level
requirements. Nonetheless, this university has produced
many good doctors in the clinical arena, at the general prac-
titioner level and many at the consultant level but I propose
to you that had you proceeded from a first degree and with
the curricular recommendations of those I have quoted today,
many of you would have become or become even better
medical scientists. This is my opinion after several years of
exposure to national and international medicine. Strive to
achieve your full potential.
86 Bartholomew

BIBLIOGRAPHY

1. Dienstag JL. Relevance and Rigor in Pre-medical

Education, N Engl J Med, 2008: 359: 221-4.

2. Jauhar S. From all Walks of Life - Nontraditional

Medical Students and the Future of Medicine, N Engl
J Med, 2008; 359: 224-7.